Quotation Estimate Ophthalmologist in United Arab Emirates Abu Dhabi –Free Word Template Download with AI
Al Noor Vision & Eye Care Centre
Corniche Road, Al Markaziyah, Abu Dhabi, United Arab Emirates
Tel: +971 2 445 6789 | Email: [email protected]
Date of Issue: 15 June 2025
Valid Until: 15 July 2025 Prepared For: Mr. Khalid Al Mansoori
Emirates ID: 784-1985-XXXXXXX-1
Address: Al Reem Island, Abu Dhabi, UAE Prepared By: Dr. Fatima Al Zaabi
Specialty: Ophthalmologist (Consultant)
License No.: DHA-OPH-2019-3342
1. Purpose of This Quotation Estimate
This Quotation Estimate is issued by Al Noor Vision & Eye Care Centre, a fully licensed and accredited ophthalmology practice located in Abu Dhabi, United Arab Emirates, to provide a detailed and transparent cost breakdown for the comprehensive ophthalmologist services requested by the patient. This document serves as a formal Quotation Estimate outlining all anticipated medical procedures, diagnostic examinations, pharmaceutical supplies, and follow-up consultations that will be performed by our qualified Ophthalmologist team. All pricing in this Quotation Estimate is quoted in United Arab Emirates Dirhams (AED) and is subject to the terms and conditions stated herein.
2. Scope of Ophthalmologist Services
The following Quotation Estimate covers a full-spectrum ophthalmologist assessment and treatment plan as recommended by Dr. Fatima Al Zaabi, Consultant Ophthalmologist, following the initial screening conducted at our Abu Dhabi, United Arab Emirates clinic. The services include diagnostic imaging, surgical intervention where indicated, post-operative care, and a structured follow-up programme spanning twelve (12) months.
3. Itemised Quotation Estimate Breakdown
| Ref. | Service / Procedure Description | Quantity | Unit Price (AED) | Subtotal (AED) |
|---|---|---|---|---|
| 01 | Comprehensive Ophthalmologist Consultation & History Review (initial visit) | 1 | 450.00 | 450.00 |
| 02 | Dilated Fundus Examination with Optical Coherence Tomography (OCT) | 2 | 380.00 | 760.00 |
| 03 | Anterior Segment Biometry & Corneal Topography Mapping | 1 | 520.00 | 520.00 |
| 04 | Visual Field Perimetry (Humphrey 30-2 & 10-2) | 2 | 310.00 | 620.00 |
| 05 | Phacoemulsification Cataract Surgery (monofocal IOL) – Ophthalmologist-led | 2 (bilateral) | 4,800.00 | 9,600.00 |
| 06 | Pre-operative Anaesthesia Assessment & Blood Work Panel | 1 | 650.00 | 650.00 |
| 07 | Post-operative Ophthalmologist Follow-up Visits (Week 1, Week 4, Month 3, Month 6, Month 12) | 5 | 250.00 | 1,250.00 |
| 08 | Prescription Medications (Antibiotic & Anti-inflammatory eye drops, 30-day supply) | 1 | 380.00 | 380.00 |
| 09 | Custom Prescription Spectacles (CR-39 lenses, standard frame) | 1 | 1,200.00 | 1,200.00 |
| 10 | Annual Comprehensive Eye Health Screening (next 12 months, Ophthalmologist supervised) | 1 | 950.00 | 950.00 |
| TOTAL ESTIMATED COST (AED) | 16,380.00 | |||
4. Payment Terms
As per this Quotation Estimate, the patient is required to settle a deposit of fifty percent (50%) of the total estimated amount, amounting to AED 8,190.00, at the time of scheduling the surgical procedure. The remaining balance of AED 8,190.00 shall be due within fourteen (14) calendar days following the completion of the final post-operative Ophthalmologist consultation. Accepted payment methods include bank transfer to our Abu Dhabi, United Arab Emirates corporate account, credit/debit card (Visa, Mastercard, Amex), and cash. All amounts are inclusive of Value Added Tax (VAT) at the prevailing UAE rate of 5%.
5. Terms and Conditions
- This Quotation Estimate is valid for thirty (30) days from the date of issue. Beyond this period, the Ophthalmologist services and associated costs may be subject to revision based on prevailing medical supply prices in the United Arab Emirates.
- All ophthalmologist procedures outlined in this Quotation Estimate will be performed by Dr. Fatima Al Zaabi or a designated Consultant Ophthalmologist of equivalent seniority at our Abu Dhabi, United Arab Emirates facility.
- The patient acknowledges that surgical procedures carry inherent risks. A separate informed consent form, compliant with the Department of Health – Abu Dhabi (DoH) regulations, must be signed prior to any operative intervention.
- Any additional procedures, medications, or diagnostic tests not explicitly listed in this Quotation Estimate will be communicated to the patient in writing before execution and will be billed separately at the Ophthalmologist's standard consultation rates.
- This Quotation Estimate does not constitute a guarantee of a specific medical outcome. The Ophthalmologist will exercise the highest standard of clinical care in accordance with the UAE Medical Code of Ethics.
- In the event of insurance coverage, the patient is advised to submit this Quotation Estimate to their insurer (e.g., Daman, ADNIC, or other UAE-licensed providers) for pre-authorisation. Our billing department in Abu Dhabi will assist with all necessary documentation.
- Confidentiality of all patient medical records is maintained in strict compliance with the UAE Federal Decree-Law No. 45 of 2021 on the Protection of Personal Data.
- Disputes arising from this Quotation Estimate shall be resolved in accordance with the laws of the United Arab Emirates, with jurisdiction vested in the courts of Abu Dhabi.
6. Acceptance and Authorisation
By signing below, the patient confirms that they have read, understood, and accepted this Quotation Estimate for the Ophthalmologist services described herein. The patient further confirms that the Ophthalmologist has explained the proposed treatment plan, alternative options, and associated risks in a language the patient understands.
Patient Signature & DateMr. Khalid Al Mansoori Ophthalmologist / Authorising Physician
Dr. Fatima Al Zaabi, Consultant Ophthalmologist
Al Noor Vision & Eye Care Centre, Abu Dhabi, UAE ⬇️ Download as DOCX Edit online as DOCX
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